RCT finds addition of aquatic activity to chronic venous insufficiency treatment is safe and effective


Results of the ATLANTIS (Aquatic therapy to lower adverse consequences of venous thrombosis and insufficiency) randomised controlled trial (RCT) show that the addition of aquatic activity to the treatment of patients with advanced chronic venous insufficiency is safe and effective, leading to significant improvement in clinical status and quality of life.

Writing in the Journal of Vascular Surgery: Venous and Lympathic Disorders, authors Mohsen Sharifi (Arizona Cardiovascular Consultants & Vein Clinic, Mesa, USA) and colleagues detail that these beneficial changes occur rapidly, within three months of initiation of aquatic activity, and are continued at a slower rate of improvement from three months to two years.

“There are conflicting reports on the efficacy of exercise in chronic venous insufficiency,” Sharifi et al begin. However, they note that exercise in water or aquatic activity has certain additional benefits over other forms of exercise therapy. For example, patients with limitations due to orthopaedic or neuromuscular problems can engaged in enhanced activity in water. In this study, the investigators sought to evaluate the clinical effects of aquatic activity in chronic venous insufficiency in a randomised, prospective, open-label fashion.

In the trial, Sharifi and colleagues included a total of 201 patients with advanced chronic insufficiency. These patients were randomised to receive either aquatic activity—which consisted of a minimum of 15 minutes of walking in a swimming pool at 1m/s, three times per week for three months—or no such treatment. Sharifi et al state that in the aquatic group, patients reached the 24-month follow-up point and in the control group, 90 patients did.

The primary efficacy endpoint was a pre-defined reduction of ≥4 points in the Venous Clinical Severity Score (VCSS) at three months, the authors write. They add that instruments of venous disease severity and quality of life were compared at baseline, three months, and 24 months between and within the two groups. These included the modified VCSS, Villalta score, leg and thigh circumference, the Physical Health Component of SF36 (SF36-PHC), and the Venous Insufficiency Epidemiological and Economic Study Quality of Life/Symptom (VEINES-QOL and VEINES-Sym) scores.

Sharifi et al report that the primary endpoint of 4-point reduction in the modified VCSS at three months was reached in 28% of the aquatic group and 3% of the control group (odds ratio [OR]: 12.08; 95% confidence interval [CI]: 3.51–41.59; p<0.001).

They add that comparison of changes in secondary endpoints from baseline to 24 months between the aquatic group and the control group demonstrated the following: VCSS -4.08±2.08 vs. -1.15±1.26, Villalta score -4±2.68 vs. -1.01±1.34, thigh circumference -3.4±1.78cm vs. -1.4±2.55cm, leg circumference -1.27±1.34cm vs. -0.49±1.21cm, SF36-PHC 3.83±2.36 vs. 1.16±1.18, VEINES-QOL 3.35±1.67 vs. 1.3±1.43, and VEINES-Sym 3.53±1.71 vs. 1.23±1.26 (p<0.001 for all comparisons).

Based on these results, Sharifi and colleagues summarise that aquatic activity is safe and effective in the treatment of chronic venous insufficiency, leading to significant reduction in VCSS and Villalta score, lower extremity oedema and size, venous symptoms, and improvement in quality of life.


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